Advances in brain injury treatment

Chewy, an 11-month-old terrier mix, was attacked by another dog. He was treated at an emergency clinic then referred to the Veterinary Specialty Hospital. When we examined Chewy, he was mentally dull, blind in the left eye and unable to walk. We were concerned about a traumatic brain and spinal injury, and an MRI was performed. It showed a skull fracture and blood clot over the brain. He also had some swelling in the spinal cord of his neck but no spinal fractures were seen. Surgery was performed to remove the fractured pieces of his skull and the blood clot.

Chewy recovered very well; he was totally normal three weeks after surgery. This successful outcome is a combination of a committed pet owner and a combined effort of the referring emergency clinic and the Veterinary Specialty Hospital, using the appropriate and current guidelines for treating a traumatic brain injury (TBI).

TBI consists of the primary or initial brain injury — the direct damage done by the impact — and secondary brain injury which may be delayed for hours and is related to continued bleeding and swelling that causes elevated intracranial pressure (ICP). The goal is to maintain blood flow by decreasing pressure inside the skull and maintaining a normal blood pressure.

A drug called mannitol is the treatment of choice for high ICP, the deadliest consequence of brain injury. Mannitol is thought to immediately increase blood flow to the brain and also to draw fluid out of the brain into the blood stream, thus reducing ICP. Another IV fluid with a similar mechanism is hypertonic saline, which has the same effect.

There’s controversy in this area over the use of corticosteroids, which were advocated in the past for people with acute spinal injuries. Much of this data has recently been called into question, because steroids have been shown to increase mortality in human head trauma patients and have been associated with other complications.

Neuroimaging (CT or MRI) with the consideration for surgery are also appropriate in the management of TBI.

Dr. David Lipsitz is a board-certified specialist in veterinary neurology at the Veterinary Specialty Hospital (vshsd.com